Assessing the predictive value of HIV indicator conditions in general practice: a case–control study using the THIN database

Abstract

BackgroundUK HIV guidelines identify 37 clinical indicator conditions for adult HIV infection that should prompt an HIV test. However, few data currently exist to show their predictive value in identifying undiagnosed HIV. AimTo identify symptoms and clinical diagnoses associated with HIV infection and assess their relative importance in identifying HIV cases, using data from The Health Improvement Network (THIN) general practice database. Design and settingA case-control study in primary care. MethodCases (HIV-positive patients) were matched to controls (not known to have HIV). Data from 939 cases and 2576 controls were included (n = 3515). Statistical analysis assessed the incidence of the 37 clinical conditions in cases and controls, and their predictive value in indicating HIV infection, and derived odds ratios (ORs) for each indicator condition. ResultsTwelve indicator conditions were significantly associated with HIV infection; 74.2% of HIV cases (n = 697) presented with none of the HIV indicator conditions prior to diagnosis. The conditions most strongly associated with HIV infection were bacterial pneumonia (OR = 47.7; 95% confidence interval [CI] = 5.6 to 404.2) and oral candidiasis (OR = 29.4; 95% CI = 6.9 to 125.5). The signs and symptoms most associated with HIV were weight loss (OR = 13.4; 95% CI = 5.0 to 36.0), pyrexia of unknown origin (OR = 7.2; 95% CI = 2.8 to 18.7), and diarrhoea (one or two consultations). ConclusionThis is the first study to quantify the predictive value of clinical diagnoses related to HIV infection in primary care. In identifying the conditions most strongly associated with HIV, this study could aid GPs in offering targeted HIV testing to those at highest risk.

Does general practice deliver safe primary care to people living with HIV? A case-notes review

“…17,24 The types of indicator conditions observed in this review correlate well with existing literature, 17,18,24 stressing the importance of focusing education and training on HIVassociated disease that is commonly seen in general practice. To the authors' knowledge, this study is the first large scale review of accuracy of GP ART recording and so data comparisons are not possible.…”

The need to scale up HIV indicator condition-guided testing for early case-finding: a case-control study in primary care

“…A Dutch case-control pilot study showed that more than half of all cases (58.5%) in a high-prevalence area had one or more ICs in the five years prior to HIV diagnosis [21]. A UK general practice case-control study found that 25.8% of HIV cases had presented with an ICs one year prior to the HIV diagnosis date [20]. In our study, 44.2% of cases had one or more ICs one year prior to the HIV diagnosis date.…”

“…A UK case-control study in primary care found multiple ICs that were associated with a subsequent HIV diagnosis [20]. …”

HIV indicator condition-guided testing to reduce the number of undiagnosed patients and prevent late presentation in a high-prevalence area: a case–control study in primary care

“…A large Italian cohort showed the importance of testing for HIV following the diagnosis of HIV indicator conditions, as this significantly decreases the probability of late HIV diagnosis 20. A UK general practice case–control study found that 25.8% of HIV cases had presented with one or more HIV indicator conditions 1 year prior to receiving a diagnosis of HIV 21. In our study, we found that 58.8% of the HIV cases had HIV indicator conditions in the 5 years prior to HIV diagnosis.…”